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      Mother and Son Suicide Pact Due to COVID-19-Related Online Learning Issues in Bangladesh: An Unusual Case Report

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          Abstract

          On 11 June 2020, a private university student (aged 22 years) and his mother (aged 47 years) from Bogra, Bangladesh, committed suicide together by ingesting poisonous gas tablets in a forest close to where they both lived (The Daily Campus 2020). The day before the suicides, the student’s father insisted that his son complete online tests because he had arranged for a broadband connection. However, the son was determined to do the tests on campus. Consequently, a huge argument between the father and son ensued and the son felt oppressed by his father. Later that evening, the son’s parents had further arguments about the situation. As a result of the arguments, the mother and son engaged in a suicide pact and killed themselves the next day after the father had left for work (The Daily Campus 2020). The term “suicide pact” usually refers to simultaneous suicides of two or more individuals of close relationship with a similar motive (Griffiths and Mamun 2020; Prat et al. 2013). This event is rare (i.e., accounts for less than 1% of the total suicides; Part et al., 2013). Most suicide pact victims are married couples, socially isolated, and often there is a serious physical illness in one or both partners (Griffiths and Mamun 2020; Prat et al. 2013). However, suicide pacts among couples reported during the COVID-19 pandemic have not followed this typical pattern (Griffiths and Mamun 2020), and the present case appears to be the first suicide pact involving son and his mother. The reasons underlying COVID-19-related suicide pacts previously reported include (i) fear of COVID-19 infection, (ii) financial problems, (iii) being socially boycotted by others, and (iv) not being able to return home from abroad (Griffiths and Mamun 2020), whereas the new case reported here relates to an unresolved argument related to online schooling issues caused by COVID-19 quarantine and spatial distancing policies. The online schooling-related quarrel and the son and mother both feeling the father’s/husband’s oppression leading to the apparent suicide pact is an unusual finding in the suicide pact literature (Part et al., 2013). Furthermore, the apparent reason for the suicides have not been reported in among COVID-19-related suicide pacts or single suicide cases published to date (e.g., Bhuiyan et al. 2020; Dsouza et al. 2020; Griffiths and Mamun 2020; Mamun and Griffiths 2020a; Mamun and Ullah 2020; Shoib et al. 2020). Previous Bangladeshi COVID-19 suicide cases have reported that financial problems caused by the national lockdown is the most prominent risk factor followed by fear of COVID-19 infection (Bhuiyan et al. 2020; Mamun and Griffiths 2020a). Findings from Bangladesh’s neighboring countries such as India and Pakistan also suggest causative reasons for suicide to be (i) testing positive with COVID-19, (ii) being quarantined because of being suspected as having COVID-19, (iii) loneliness due to lockdown, (iv) social boycotting of those suspected of being infected with COVID-19, (v) COVID-19 work-related stress, (vi) being unable to come back home because of lockdown, and (vii) the unavailability of alcohol for individuals with alcohol use disorder (Dsouza et al. 2020; Mamun and Ullah 2020; Shoib et al. 2020). Although suicide in Bangladesh due to academically related issues has been reported (e.g., exam failure, academic distress, quarreling and disagreeing with parents about what subjects to study, etc. (Mamun and Griffiths 2020b, 2020c, 2020d, 2020e; Mamun et al. 2020a, 2020b), no previous Bangladeshi student suicide cases have been reported in a COVID-19-related context. A previous Indian victim was reported as being due to a COVID-19-related educational issue (i.e., a student being depressed due to exam postponement) but no suicides or suicide pacts as a consequence of online education-related issues caused by the pandemic have been reported in Bangladesh (Dsouza et al. 2020). Additionally, an Indian teenage girl committed suicide because of being unable to attend online classes because she did not have a smartphone or a functional television to access the online materials (Lathabhavan and Griffiths 2020). The world has changed dramatically since the start of the COVID-19 pandemic and this has included education at all levels. For instance, it has been estimated that since the beginning of April 2020, approximately 90% of the total enrolled learners (i.e., 1.5 billion students) from 185 countries have been involved in little or no educational activities because of schools and higher education institutions’ closure (Marinoni and de Wit 2020). Many universities implemented online classes and examinations to combat the lack of face-to-face contact. In Bangladesh (where the present suicide case was reported), the Minister of Education instructed all universities to introduce online education. Although this is perceived by some as an education-friendly policy (Islam 2020), a recent survey among 2038 students in 45 higher education institutes found that one-third of Bangladeshi students did not want to engage in online academic activities (Islam et al. 2020). The same study also reported that 55% of the students were not supported with proper Internet connections and 44.7% did not have access to a large screen smart device (i.e., laptop, PC, tablet, etc.) to engage effectively in online teaching (Islam et al. 2020). One of the most challenging aspects in attending online classes can be the residing location of the student. In rural areas, the accessibility of the high-speed Internet and broadband connections are limited. The online assessments and online class teaching are only feasible and effective for a small proportion of students (i.e., 13 and 18%, respectively; Islam et al. 2020). Consequently, restlessness and agitation among many students who have been forced to engage in online teaching and testing are not uncommon (Islam 2020). Such academically-related psychological burdens may lead to unstable mental states and suicidality in the extreme cases (Mamun and Griffiths 2020d, 2020e; Griffiths et al. 2020; Mamun et al. 2020a, 2020b). Based on the aforementioned discussion, it is evident that Bangladeshi as well as other low- and middle-income countries’ (LMICs) governments should think carefully about online schooling before making it compulsory. Students from LMICs are much less likely to have access to the technology and related materials to support online schooling (i.e., large screens, high-speed Internet access, etc.). Furthermore, there has been a great economic crisis throughout the world (which also accounts for most of the COVID-19-related suicides in LMICs; Bhuiyan et al. 2020; Dsouza et al. 2020; Griffiths and Mamun 2020; Mamun and Ullah 2020). Students who experience financial distress in their family and community have an increased likelihood of mental instability (Rafi et al. 2019). Therefore, policymakers in LMICs should keep in mind that student well-being should come before mandatory online education when making decisions about schooling during the pandemic.

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          First COVID-19 suicide case in Bangladesh due to fear of COVID-19 and xenophobia: Possible suicide prevention strategies

          The novel coronavirus 2019 (COVID-19) pandemic has become a global concern. Healthcare systems in many countries have been pushed to breaking point in an attempt to deal with the pandemic. At present, there is no accurate estimation about how long the COVID-19 situation will persist, the number of individuals worldwide who will be infected, or how long people’s lives will be disrupted (Suicide Awareness Voices of Education, 2020; Zandifar and Badrfam, 2020). Like previous epidemics and pandemics, the unpredictable consequences and uncertainty surrounding public safety, as well as misinformation about COVID-19 (particularly on social media) can often impact individuals’ mental health including depression, anxiety, and traumatic stress (Cheung et al., 2008; Zandifar and Badrfam, 2020). Additionally, pandemic-related issues such as social distancing, isolation and quarantine, as well as the social and economic fallout can also trigger psychological mediators such as sadness, worry, fear, anger, annoyance, frustration, guilt, helplessness, loneliness, and nervousness. These are the common features of typical mental health suffering that many individuals will experience during and after the crisis (Ahorsu et al., 2020; Banerjee, 2020; Cheung et al., 2008; Xiang et al., 2020). In extreme cases, such mental health issues can lead to suicidal behaviors (e.g., suicidal ideation, suicide attempts, and actual suicide). It is well stablished that around 90 % of global suicides are due to individuals with mental health conditions such as depression (Mamun and Griffiths, 2020). Similar situations have been reported in previous pandemics. For example, the suicide rate among elderly people increased in Hong Kong both during and after the SARS (Severe Acute Respiratory Syndrome) pandemic in 2003 (Cheung et al., 2008). On March 25 (2020), after returning from Dhaka, a 36-year-old Bangladeshi man (Zahidul Islam, from the village of Ramchandrapur) committed suicide because he and the people in his village thought he was infected with COVID-19 based on his fever and cold symptoms and his weight loss (Somoy News, 2020). Due to the social avoidance and attitudes by others around him, he committed suicide by hanging himself from a tree in the village near his house. Unfortunately, the autopsy showed that the victim did not have COVID-19 (Somoy News, 2020). The main factor that drove the man to suicide was prejudice by the others in the village who thought he had COVID-19 even though there was no diagnosis. Arguably, the villagers were xenophobic towards Mr. Islam. Although xenophobia is usually defined as a more specific fear or hatred of foreigners or strangers, xenophobia is actually the general fear of something foreign or strange (in this case COVID-19 rather than the victim’s ethnicity). Given that the victim believed he had COVID-19, it is also thought that he committed suicide out of a moral duty to ensure he did not pass on the virus to anyone in his village. A very similar case was reported in India on February 12 (2020), where the victim, returning from a city to his native village, committed suicide by hanging to avoid spreading COVID-19 throughout the village (Goyal et al., 2020). Based on these two cases, it appears that village people and the victim’s moral conscience had major roles in contributing the suicides. In the south Asian country like Bangladesh and India, village people arguably less educated than those that live in cities. Therefore, elevated fears and misconceptions surrounding COVID-19 among villagers may have led to higher levels of xenophobia, and that xenophobia may have been a major contributing factor in committing suicide. Suicide is the ultimate human sacrifice for anyone who cannot bear the mental suffering. However, the fact that the fear of having COVID-19 led to suicide is preventable and suggests both research and prevention is needed to avoid such tragedies. At present, it is not known what the level of fear of COVID-19 is among the Bangladeshi population although levels of fear are high among countries where there have been many deaths such as Iran according to a recent study examining fear of COVID-19 (Ahorsu et al., 2020). We would suggest there is an urgent need to carry out a nationwide epidemiological study to determine the level fear, worry, and helplessness, as well as other associated issues concerning mental health in relation to COVID-19. This would help in developing targeted mental wellbeing strategies (e.g., such as those who live in villages). Additional mental health care is also needed for patients confirmed as having COVID-19, patients with suspected COVID-19 infection, quarantined family members, and healthcare personnel (Xiang et al., 2020). We would also suggest the following to the general public: (i) avoid unreliable and non-credible news and information sources (such as that on social media and what neighbors say) to reduce fear and panic surrounding COVID-19, (ii) help individuals with known mental health issues (e.g., depression, anxiety) in appropriate ways such as consultation with healthcare professionals using telemedicine (i.e., online interventions) where possible, (iii) offer support and signposting for individuals displaying pre-suicidal behavior (i.e., talking about death and dying, expressing feelings of being hopeless and/or helpless, feeling like they are a burden or that they are trapped), (iv) offer basic help (e.g., foods, medicines) to those most in need during lock-down situations (Suicide Awareness Voices of Education, 2020; Yao et al., 2020). We would also recommend online-based mental health intervention programs as a way of promoting more reliable and authentic information about COVID-19, and making available possible telemedicine care, as suggested in recent previous papers (Liu et al., 2020; Xiang et al., 2020; Yao et al., 2020). Finally, as suggested by Banerjee (2020), the role of a psychiatrist during a pandemic such as COVID-19 should include as (i) educating individuals about the common adverse psychological consequences, (ii) encouraging health-promoting behaviors among individuals, (iii) integrating available healthcare services, (iv) facilitate problem-solving, (v) empowering patients, their families, and health-care providers, and (vi) promoting self-care among health-care providers. Role of the funding source Self-funded. Financial disclosure The authors involved in this research project do not have any relationships with other people or organizations that could inappropriately influence (bias) their work. Declaration of Competing Interest The authors of the correspondence do not have any conflict of interest.
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            • Record: found
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            Aggregated COVID-19 suicide incidences in India: Fear of COVID-19 infection is the prominent causative factor

            Many Indian COVID-19 suicide cases are turning the press-media attention and flooding in the social media platforms although, no particular studies assessed the COVID-19 suicide causative factors to a large extent. Therefore, the present study presents 69 COVID-19 suicide cases (aged 19 to 65 years; 63 cases were males). The suicide causalities are included as follows – fear of COVID-19 infection (n=21), followed by financial crisis (n=19), loneliness, social boycott and pressure to be quarantine, COVID-19 positive, COVID-19 work-related stress, unable to come back home due to lockdown, unavailability of alcohol etc. Considering the extreme psychological impacts related to COVID-19, there emerges a need for countrywide extensive tele-mental health care services.
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              COVID-19 suicides in Pakistan, dying off not COVID-19 fear but poverty? – The forthcoming economic challenges for a developing country

              Highlights • Suicide increment during and afterwards a pandemic is highly common. • This study reports COVID-19 suicide cases in Pakistan for the first time. • Most of the suicides occur due to lockdown-related economic recession. • Fear of infection is the second suicide contributing factor. • Lockdown-related unemployment aggravates the life-threatening situation.
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                Author and article information

                Contributors
                mark.griffiths@ntu.ac.uk
                Journal
                Int J Ment Health Addict
                Int J Ment Health Addict
                International Journal of Mental Health and Addiction
                Springer US (New York )
                1557-1874
                1557-1882
                7 July 2020
                : 1-4
                Affiliations
                [1 ]Undergraduate Research Organization, Savar, Dhaka, Bangladesh
                [2 ]GRID grid.411808.4, ISNI 0000 0001 0664 5967, Department of Public Health & Informatics, , Jahangirnagar University, ; Savar, Dhaka, Bangladesh
                [3 ]Comprehensive Competency Training on Nutrition, National Institute of Preventive and Social Medicine, Dhaka, Bangladesh
                [4 ]GRID grid.12361.37, ISNI 0000 0001 0727 0669, Psychology Department, , Nottingham Trent University, ; 50 Shakespeare Street, Nottingham, NG1 4FQ UK
                Author information
                http://orcid.org/0000-0001-8880-6524
                Article
                362
                10.1007/s11469-020-00362-5
                7340761
                21f4e97e-efdb-49e6-b6f0-1672beca0841
                © Springer Science+Business Media, LLC, part of Springer Nature 2020

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

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